Reading of the Week: The Future of Psychiatry – Part II of II

From the Editor

Is mental health becoming too technical (and forgetting patients as a result)?

The future of us clinicians?

This is the second Reading in a two-part series considering the future of mental health – not in terms of distant developments like biomarkers and genetically-tailored drugs – but rather by looking at measurement-based care and the evolution of the field.

Last week, measurement-based care.

This week, the end of the art of care?

This week, we look at an editorial The British Journal of Psychiatry that warns against physicians becoming “well treated skilled workers.”

And, continuing the consideration of ‘the future,’ we also consider a new paper that has received much attention. Can a web-based intervention help with insomnia? Spoiler alert – as The New York Times reported last week, “more than half of chronic insomniacs who used an automated online therapy program reported improvement within weeks and were sleeping normally a year later.”

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Reading of the Week: The NEJM on “Our Struggle to Care for People with Serious Mental Illness”

From the Editor

What can we do for those with severe mental illness?

Homelessness: can we do better?

This week, we look at a series of excellent essays that have run on mental illness in The New England Journal of Medicine. They are well written and insightful. We particularly focus on the first of the three essays, which considers treatment and rights.

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Reading of the Week: The New CANMAT Guidelines for Depression

From the Editor

What’s new in depression treatment?

The new guidelines

This week, we look at the new CANMAT guidelines. Published in September in The Canadian Journal of Psychiatry, the papers – six in all – speak to the latest in depression management.

What should you think about the new antidepressants? What alternatives are there to CBT? What to do when everything else fails? Spoiler alert: this week’s Reading answers all these questions and more.

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Reading of the Week: The Placebo Effect and Antidepressants

From the Editor

Is the placebo effect getting stronger with time?

image001Placebo pills – greater importance?

Since the first writings of English physician John Haygarth at the turn of the 19th century, the placebo effect is something well documented and well discussed – but not well understood. How can people respond to sugar pills and the like?

Even more oddly, the placebo effect seems to be changing with time, at least in terms of antidepressant medications. In a classic paper published about a decade and a half ago, Walsh et al. found that the placebo effect was getting more pronounced over the years. Dr. Timothy Walsh joked in a Washington Post interview that “[t]hey’re making placebos better and better.” Besides being an interesting finding, there are larger issues – start with the implications to drug development. After all, if the placebo effect is rising, it becomes more challenging to develop a drug that bests it.

Have things changed since the publication of the Walsh et al. paper?

In this week’s Reading, we consider the new Furukawa et al. paper. This study, which reviewed 250 plus randomized controlled trials that involved more than 26,000 patients and included unpublished data, found that the placebo effect isn’t increasing. Also in the Reading: an editorial commenting on the Furukawa et al. paper.

Please note – there will be no Reading next week.

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“Mental Health Now!”

From the Editor

Will they cut a deal?

Ontario Minister of Health and Long-Term Care Eric Hoskins speaks during a health ministers’ meeting last week in Toronto

It’s the question that will be discussed for weeks to come.

But for those of us in mental health, a possible deal is more than an item on the evening news. After all, a new federal-provincial accord could be important, with more money for mental health services. And let’s remember: right now, just 7 cents on every dollar of health spending goes to mental health (in the UK, by contrast, spending is 12 cents on the dollar).

But we hope for more than just a new deal. We hope for a smart new deal – one that will help improve mental health services.

What are steps the federal government could take?

This week’s Reading considers the new report issued by the Canadian Alliance on Mental Illness and Mental Health (or CAMIMH), an alliance of sixteen member organizations, including the Canadian Psychiatric Association, the Canadian Medical Association, and the College of Family Physicians of Canada. This thoughtful document lays out a five-point plan for bettering mental health services from coast-to-coast-to-coast. Spoiler alert: the plan calls for more spending, yes, but also efforts to improve access, better measurement of the system, and a targeted basic income to help less affluent Canadians.

Also in this reading – tying back to the UK – we look at an article from The Guardian about making mental health services stronger across the Atlantic.

The two pieces offer a strong contrast: about where our debate is in this country – and where mental health services could be with some needed reforms.

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Reading of the Week: First Episode Psychosis and Access – The Anderson-Kurdyak Paper, and More

From the Editor

“If your son or daughter had cancer or diabetes, do you think it would be reasonable for them to wait? I don’t think it’s any different for mental illness.”

Access. It’s one of the biggest problems with mental health services.

How big is the access problem? What can be done about it?

This week, we consider a new paper looking at access and first episode psychosis. Dr. Paul Kurdyak, a CAMH psychiatrist and a program lead with the Institute for Clinical Evaluative Sciences, made the above comment to the CBC when discussing this new paper. In it, Kelly Anderson and Dr. Kurdyak find that 40% of patients didn’t receive physician follow-up in the month after diagnosis. Imagine – tying back to Dr. Kurdyak’s comment – if 40% of young patients with leukemia didn’t have physician follow-up in a month after their cancer diagnosis.

We also look at the discussion around a new federal-provincial accord with an op ed written by Michael Wilson, the chair of the Mental Health Commission of Canada – particularly timely as the ministers of health met this week with an eye on a new accord.

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Reading of the Week: Starbucks’ Big Mental Health Announcement, and More

From the Editor

Readings in recent weeks have drawn from several journals and a major autobiography.

Recognizing that mental health is increasingly part of our public and private conversations, we draw from newspapers and news sites this week.

image001Starbucks: fraps, breakfast sandwiches, and psychotherapy (for employees)

The decision of Starbucks to expand employee coverage for psychotherapy leads this week’s lineup.

We also consider the first Parliamentary speech of an Australian politician and a new British exhibit of old art – from asylums.

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Reading of the Week: What’s New in Psychotherapy – Paul Garfinkel’s Book

From the Editor

What’s new in psychotherapy?

Psychotherapy is an area of psychiatry transformed over the past years.

Dr. Aaron Beck: not a Freudian

Last week, we looked at a major new paper on IPT. This week, we return to Dr. Paul Garfinkel’s book – the source of two past Readings – for an excellent chapter on psychotherapy.

Last week. A major new review of IPT.

This week. An overview of psychotherapy developments.

This chapter describes the evolution of psychotherapy, and its importance. It also notes the excellent opportunity for the mental health field – to embrace evidence-based treatments and to offer better care for our patients.

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Reading of the Week: What’s New in Psychotherapy – The Cuijpers et al. Paper

From the Editor

What’s new in psychotherapy?

If there is one area of psychiatry that seems to have been transformed in recent years, it’s psychotherapy. Not surprisingly, then, past Readings have looked at the expanded role of short-term, evidenced-based therapies – in particular, Cognitive Behavioural Therapy, or CBT.

Today’s psychotherapy: a long way from Freud

Over the next two weeks, we’ll look in more detail at new developments in psychotherapy.

This week. A major new review of IPT.

Next week. An overview of psychotherapy developments.

This week, we consider a new paper published in The American Journal of Psychiatry on Interpersonal Therapy, or IPT. This paper is clear, lucid, and worth reading.

Is there evidence for IPT? Yes – and more than just for depression.

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Reading of the Week: Kurdyak’s New Paper on Access

From the Editor

As medical school classes have grown, the supply of physicians has increased across the country. Has this helped address access issues in psychiatry?

How have practice patterns changed over time?

This week’s Reading seeks to answer some basic and important questions around physician supply and access in psychiatry. Following up on a major paper written in 2014, Kurdyak et al. have written another important and relevant paper.

The long and the short of it: there are significant problems with access – and they aren’t getting any better with time.

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